Epilepsy Flashcards
Epilepsy = seizure. True or false?
False
What is a seizure
Abnormal discharge of electrical activity in the brain
What is epilepsy?
Tendency to get recurrent seizures
Interruption of normal brain activity due to abnormal synchronisation of neuronal activity
Epileptic attacks are usually long/short?
Short
Focal seizures - definition
Discharge is confined to one area of the brain and doesn’t spread elsewhere.
Part of the brain is structurally abnormal which causes irritation and focal seizures in that area.
Simple focal seizure vs complex focal seizure
Simple - without impaired consciousness
Complex - with impaired consciousness
Focal epilepsy is more common in younger/older people?
Older
- because as you get older, you are more likely to have a structural brain abnormality
Generalised seizure - definition
Discharge spreads to more than 1 area of the brain.
There is more than one pathway involved.
Generalised seizures start a which networks?
Cortical networks
Generalised epilepsy is more common in younger/older people?
Younger
- has a genetic predisposition
Name the seizure: patient gets interrupted from participating in an activity and gives a vacant blank stare then resumes to activity
Absence seizure
What does myoclonus mean?
Body jerks
What is an atonic seizure?
Patient collapses to the ground and looses muscle tone
What are the characteristics of a tonic seizure?
Patient’s body goes rigid
There is an abnormal discharge in both motor cortices in the brain
Describe a tonic clonic seizure
Initially part of the body goes rigid and then later, the clonic component (jerking) occurs
Types of movements
Stiff Rigid Jerking Tongue biting Urinary incontinence
Questions to ask about after the event?
How long did it take to recover?
Sleepiness/disorientation
Which types of drugs can precipitate seizures?
Antibiotics
Tramadol
If a patient presents with their first seizure, they are routinely examined. True or false?
False
What are the rules of driving after first seizure?
Can’t drive car for 6 months
Can’t drive HGD/PCV for 5 years
For anyone who presents with a seizure, what is the first line investigation?
ECG
Imaging
MRI scan
CT scan
EEG - what is it
Stick electrodes on the head and look for brainwave changes
EEG is a useful investigation. True or false?
False
What are the 4 purposes of EEG
How you classify someone’s epilepsy
To confirm non-epileptic attacks
Surgical evaluation
Conformation of non-convulsive status
You should do an EEG in anyone under 30. Why is this?
To differentiate between generalised and focal seizures
Management of focal epilepsy
Carbamazepine
Lamotrigine
Considerations of drugs with carbamazepine
Makes contraceptive pill and morning after pill less effective
Generalised epilepsy management
Sodium valproate
Lamotrigine
Sodium valproate - side effets
Teratogenic
Sodium valproate is more/less effective than lamotrigine.
More
Management of generalised epilepsy - which drug is used more often: lamotrigine, sodium valproate?
Lamotrigine
What is the first line treatment in generalised epilepsy
Lamotrigine
Why must you start low and go slow with lamotrigine dosage?
If you start immediately on a high dose then it can cause steven johnson syndrome
Management of absence seizures
Sodium valproate
Ethosuximide
Management of myoclonic seizures
Sodium valproate
Clonezapam
Patients on anti-convulsant medication should avoid which contraceptive pill?
Progesterone only pill
Anti-convulsants affect the efficacy of the combined oral contraceptive pill and the morning after pill. True or false?
True
Status epilepticus - definition
Recurrent epileptic seizures without full recovery of consciousness
Status epilepticus - onging seizure activity for over _____ mins
30
Status epilepticus - causes
Abrupt withdrawal from anti-convulsants
Head trauma
Sub-arachnoid haemorrhage
Infections
Management of status epilepticus - if controlled
50ml 50% glucose if there is any suggestion of hypoglycaemia
IV thiamine if there is any suggestion of alcohol abuse or nutrient insufficiency
SUDEP - definition
Sudden Unexpected Death in Epilepsy
SUDEP - risk factors
Increased seizure frequency
Aspiration
Nocturnal seizures
Poor compliance with medications
Non epileptic attack - definition
Unable to envisage where in the brain the abnormal discharge is coming from
Non epileptic attack - causes
Traumatic events
Physical/Sexual abuse
Stress, anxiety, depression
Non epileptic attacks - clinical features
Coordinated movements - patient kicks legs - pelvic thrusts Patient has no control of the attacks Patient is conscious Patient is definite and absolute in what they experience
Manage non epileptic attacks with anti-convulsants. True or false?
False
- these make the attacks worse
Management of non epileptic attacks
Counselling
The patient will only recover once they accept what the underlying trauma is
Nocturnal seizures are always the same. True or false ?
True
A patient presents with hypo pigmented skin, generalised seizures and fibromatas. What is the most likely diagnosis? A men2 B men1 C neurofibromatosis 1 D neurofibromatosis 2 E tuberous sclerosis
Tuberous sclerosis
Which anticonvulsant should never be given in generalised epilepsy?
Sodium valproate
Lamotrigine
Carbamazepine
Carbamazepine
Febrile convulsions are a recognised risk factor for the development of focal onset seizures in which brain lobe in later life?
Temporal lobe
Which type of seizure involves characteristic pelvic thrusting and head turning movements? Epilepsia partialis continua Non epileptic disorder Primary seizure Generalised seizure Status epilepticus
Non epileptic disorder
